2 dysphagia 181014 revisi
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181014 1
CURRICULUM VITAE
Full Name : MOHAMMAD SAIFUL-ISLAM doctor, neurologist, consultant (cerebroascular!
"osition#$ob %itle : Medical Sta&&, Stro'e Unit, Deartment o&
Neurolog), Facult) o& Medicine Airlangga Uniersit)#Dr Soetomo *eneral Hosital,
Suraba)a
+ducational ecords : Medical Doctor, Facult) o& Medicine AirlanggaUniersit), Suraba)a Secialist in Neurolog), Facult) o& Medicine, Airlangga Uniersit), Suraba)a %raining "rogram in te .linical Management o& Stro'e "atients at Sir .arles *airdner Hosital, "ert, /estern Australia (0112!
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181014 FOEL 2
NEUROLOGIC ASPECTON
DYASPHAGIA
Moammad Sai&ul-Islam
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Dysphagia is common and has !!n "!po"#!d #o !p"!s!n# in $%&' o( p!"sons ) ag! $*
M!chanica+ dysphagia Oral: Am)loidosis, congenital
abnormalities, Intraoral tumor, liin3uries, macroglosia,scleroderma, %M$ d)s&untion,4erostomia
"ar)ngeal: .erical antosteo)tes, diteria,t)romegal), retroar)ngealabscess#tumor
+soageal: .austic in3ur),esoageal .a#dierticulum#in&ection#stricture#ulceration,*+D, iatal ernia, osteriormediastinal mass
Pfeiffer RS. NICP 2012;153-163
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Dysphagia is common and has !!n "!po"#!d #o !p"!s!n# in $%&' o( p!"sons ) ag! $*
N!,"om,sc,+a"dysphagia
Oroar)ngeal: in&lammator)m)osties, mitocondrialm)oat), muscular d)stro),NM$ disorders (M*, L+MS,botulism!, scleroderma, sti&& mans)ndrome
+soageal: Am)loidosis,In&lammator) m)oaties(dermatom)ositis, ol)m)ositis,scleroderma
Pfeiffer RS. NICP 2012;153-163
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181014 FOEL 5
Dysphagia is common and has !!n "!po"#!d #o !p"!s!n# in $%&' o( p!"sons ) ag! $*
N!,"og!nic dysphagia
Oroar)ngeal: Arnold-.iar)mal&ormation, basal gangliadiseases (DL5, HD, MSA, "D,
"S", /ilson disease!, ."M, .",drug related, in&ection (rabies,encealitis, oliom)elitis!, masslesion (tumor, emorrage,abscess!, motor neuron disease(ALS!, MS, erieral neuroat)
(*5S!, sinocerebellar ata4ia,s)ringobulbia, stro'e
+soageal: Acalasia, autonomicneuroat), "D, esoagealmotilit) disorders, .agas diseasePfeiffer RS. NICP 2012;153-163
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181014 FOEL 6
IMPAIRED S-ALLO-ING OR DYSPHAGIAocc,"s .,i#! ("!.,!n#+y in n!,"o+ogica+ pa#i!n#s
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181014 FOEL 7
HO- COMMON ISDYSPHAGIA A/TER STRO0E 1
Diagn!"i#"e#$ni%&e
In#i'en#e f'(!)$agia
C,"so"y
sc"!!ning#!chni.,!
37-45%
C+inica+#!s#ing
51-55%
Ins#",m!n#a+#!s#ing 2V/S3
64-78%
*ar"in R e" a+. S"r,e 2005;362756-2763
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DOES DYSPHAGIA MATTER 1
DYSPHAGIAIN ACUTE STRO0E PATIENTS IS A
MAR0ER O/ POOR PROGNOSIS
MALNUTRITIONDEHYDRATIONASPIRATIONPNEUMONIA
PROLONGED HOSPITAL STAYINCREASED MOR4IDITY 5 MORTALITY
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DOES DYSPHAGIA MATTER 1
S#,dy Dysphagic Non%Dysphagic
RR 2"andom3
6$' CI
-!igh#2'3
RR2"andom3
6$' CI
C$&a e" a+
DePi)) e" a+
/r'n e" a+
/""i+e e" a+*ann e" a+
Si"$ar' e" a+
Sa+a e" a+
To#a+5 CI
621
1082
737
502482
2060
1168
&789**
232
157
450
130246
57
211
:6896;
7.4
4.40
13.2
22.6.16
34.05
8.21
;**
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O"opha"yng!a+ dysphagiais "!po"#!d ?i#h an incid!nc! o( 7*@;**' inpa#i!n#s ?i#h Pa">insons dis!as!
C+ini#a++( re+ean" !a++ing
i)airen" i! genera++(
a!!#ia"e' i"$ a'an#e'
!"age f "$e 'i!ea!e I" re'e! %&a+i"( f +ife
#)+i#a"e! e'i#a"in in"a,e
an' +ea'! " a+n&"ri"in an'
a!)ira"in )ne&nia $i#$ i!a a9r #a&!e f 'ea"$ in
Par,in!n:! 'i!ea!e
Suntru S et al6 Brain 7809136; 726738
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NEURAL MECHANISMS O/ S-ALLO-ING
Subcortical andcortical sensorimotor
Medullar) s;allo;ing
centerMotor outut (Nn6
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NEURAL MECHANISMS O/ S-ALLO-ING
BRAINSTEM
S7a++7ingCen"e
r
THALAMUS
SENSORI-MOTOR NEOCORTEX
inferir )re- an' )!"-#en"ra+ g(r&!
!+ihoodo( s?a++o?ing p"o+!ms
Decrease LOC
!""r s#$$#& 'a(ace D")'(e *e+#,ares#s O(er a&e A'"r+a( $"&)e,a(a$a( +".e+e$ /ea0 "r a'se$ ."()$ar c")&*
M"#s$ "r ')''(#& ."#ce E.#ece "2 ,e)+"#a Re)ce ,*ar&ea( sesa$#"
ESOPHAGEALPHASE
P"ima"y #!s#
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ASSESSMENT O/ S-ALLO-ING
B CLINICAL /EATURES
D)soniaD)sartriaAbnormal gag re&le4Abnormal olitional coug
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MANAGEMENT
GOALS
"reention o&asiration,
de)dration,malnutrition
eabilitation o&d)s&unction
eestablisment o&oral inta'e
COMPENSATORYSTRATEGY
%o 'ee atients sa&e
;en eating
REHA4ILITATIVE
STRATEGY %o seed te recoer)rocess
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COMPENSATORY TREATMENT
Nil b) mout
(N5M! N* and "+*
&eeding
Feeding
training
Ne&r+gi#a+ ar' Dr Se" !)i"a+ S&raa(a D#.
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SUMMARY
Neurogenicd)sagia
.ommon roblemin neurologicaldiseases
Neural
mecanismsAssessmentManagement
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180512 FOEL 22220711 FOEL 22
22
Suramadu Long Bridge(Surabaya-Madura)
THAN0 YOU
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